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Esophageal luminal temperature rise during atrial fibrillation ablation is associated with lower radiofrequency electrode distance and baseline impedance
Author(s) -
Khoshknab Mirmilad,
Kuo Ling,
Zghaib Tarek,
Arkles Jeffrey,
Santangeli Pasquale,
Marchlinski Francis E.,
Han Yuchi,
Desjardins Benoit,
Nazarian Saman
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.15097
Subject(s) - medicine , esophagus , atrial fibrillation , ablation , radiofrequency ablation , lesion , cardiology , catheter ablation , magnetic resonance imaging , ablation of atrial fibrillation , radiology , surgery
Esophageal injury during atrial fibrillation (AF) ablation is a life‐threatening complication. We sought to measure the association of esophageal temperature attenuation with radiofrequency (RF) electrode impedance, contact force, and distance from the esophagus. Methods The retrospective study cohort included 35 patients with mean age 64 ± 10 years, of whom 74.3% were male, and 40% had persistent AF. All patients had undergone preprocedural cardiac magnetic resonance (CMR) followed by AF ablation with luminal esophageal temperature monitoring. Lesion locations were co‐registered with CMR image segmentations of left atrial and esophageal anatomy. Luminal esophageal temperature, time matched RF lesion data, and ablation distance from the nearest esophageal location were collected as panel data. Results Luminal esophageal temperature changes corresponding to 3667 distinct lesions, delivered with mean power 27.9 ± 5.5 W over a mean duration of 22.2 ± 10.5 s were analyzed. In multivariable analyses, clustered per patient, examining posterior wall lesions only, and adjusted for lesion power and duration as set by the operator, lesion distance from the esophagus (−0.003°C/mm, p < .001), and baseline impedance (−0.015°C/Ω, p < .001) were associated with changes in luminal esophageal temperature. Conclusion Esophageal luminal temperature rises are associated with shorter lesion distance from esophagus and lower baseline impedance during RF lesion delivery. When procedural strategy requires RF delivery near the esophagus, selection of sites with higher baseline impedance may improve safety.